$11.5M claim on UMMHC; Medicaid audit reveals overpayment in 2000.


Byline: Aaron Nicodemus

WORCESTER - A federal audit of Medicaid payments has concluded that UMass Memorial Health Care Inc. overcharged the Medicaid program by $11.5 million for medical services provided in 2000 and 2001.

After spending more than four years examining $1.2 billion worth of Medicaid reimbursements made to UMass Memorial, the Department of Health and Human Services' Office of Inspector General has recommended UMass Memorial repay $11.5 million, half to the federal government and half to the state of Massachusetts.

The audit also questioned the "appropriateness" of UMass Memorial Health Care Inc. sending $5.6 million in Medicaid claim money to the University of Massachusetts Medical School. UMass Memorial Health Care is allowed to charge Medicaid more for some medical services, which it passes along to the medical school. The OIG noted in its report that it was "unable to express an opinion" on the $5.6 million paid to the medical school.

The OIG audit is only a recommendation, according to Don White, an OIG spokesman. The Centers for Medicare and Medicaid Services, the state of Massachusetts Executive Office for Health and Human Services, and UMass Memorial will now go into negotiations to determine how much, if any, money UMass Memorial should repay.

"We've got our recommendations in the report, but our recommendation is often not followed," Mr. White said. "It's up to the parties involved to determine the proper outcomes."

Douglas S. Brown, senior vice present...

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